Paškevičius, Rokas

High-pressure injection injuries pose serious risks to hand function and are often underestimated. They occur when fluid or air under pressure punctures the skin leading to internal damage that can be devastating. Immediate surgical intervention, including debridement and irrigation, is essential to prevent long-term complications. Despite advancements in treatment, long-term morbidity and functional impairment are common, highlighting the need for thorough management and postoperative physiotherapy. This case emphasizes a crucial aspect: although high-pressure injection injuries may present initially as benign they should be treated as urgent situations that could be missed without thorough history-taking and appropriate diagnostic measures.

Dupuytren’s contracture (DC) represents a chronic fibroproliferative pathology of the palmar aponeurosis, which leads to flexion contractures of finger joints and hand disability. In recent decades, the WNT signaling pathway has been revealed to play a significant role in the manifestation and pathogenesis of DC. Our study aimed to evaluate the associations between Dupuytren’s contracture and WNT-related single-nucleotide polymorphisms: Wnt Family Member 7B (WNT7B) rs6519955 (G/T), Secreted Frizzled Related Protein 4 (SFRP4) rs17171229 (C/T) and R-spondin 2 (RSPO2) rs611744 (A/G). We enrolled 216 patients (113 DC cases and 103 healthy controls), and DNA samples were extracted from the peripheral blood. Genotyping of WNT7B rs6519955, SFRP4 rs17171229 and RSPO2 rs611744 was performed using the Real-Time PCR System 7900HT from Applied Biosystems. WNT7B rs6519955 genotype TT carriers were found to possess a higher prevalence of DC (OR = 3.516; CI = 1.624–7.610; p = 0.001), whereas RSPO2 rs611744 genotype GG appears to reduce the likelihood of the manifestation of DC nearly twofold (OR = 0.484, CI = 0.258–0.908, p = 0.024). In conclusion, SNPs WNT7B rs6519955 and RSPO2 rs611744 are associated with the development of Dupuytren’s contracture: WNT7B rs6519955 TT genotype increases the chances by 3.5-fold, and RSPO2 rs611744 genotype GG appears to attenuate the likelihood of the manifestation of DC nearly twofold. Findings of genotype distributions among DC patients and control groups suggest that SFRP4 rs17171229 is not significantly associated with development of the disease.

Sprogdintiniai ir šautiniai riešo ir plaštakos sužalojimai Lietuvoje mažai analizuota tema, nors ji ypač aktuali, nes sutrikus ar visiškai netekus plaštakos funkcijos, labai suprastėja žmogaus gyvenimo kokybė ir darbingumas. Šalyje sprogdintiniai plaštakos sužalojimai pasitaiko ženkliai dažniau, nei šautiniai. Pagrindinė sprogdintinių sužalojimų priežastis – neatsargus ir neatsakingas pirotechnikos gaminių naudojimas. Straipsnyje apžvelgiami 6 metų Lietuvos ir Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikose (LSMUL KK) gydytų pacientų, patyrusių sprogdintines ir šautines plaštakos traumas, statistiniai duomenys, aptariami sužalojimo masto dėsningumai.

Introduction Dupuytren‘s contracture (DC) is a progressing fibroproliferative hand disorder of polygenetic and multifactorial origin [1,2]. DC presents as thickening of the palmar aponeurosis [1]. It results in the development of longitudinal bands and formation of contractures in the digits [1,2]. The prevalence of DC ranges widely from 2 to 42 % [3,4]. Treatment of DC is aimed at excision or fragmentation of the fibrous bands and the residual extension deficit is established as a hallmark of treatment effectiveness [5]. Limited partial fasciectomy is a widely accepted traditional surgical approach [6,7]. Even though recent decade has marked increased interest in minimally invasive methods there is still lack of studies evaluating limited partial fasciectomy in a modern surgery setting. Aim Evaluate limited partial fasciectomy effectiveness in treatment of DC by comparing pre- and postoperative extension deficit of the digits and disability of the upper limb. Methods A prospective study was performed, including patients admitted to the department of Plastic and Reconstructive Surgery, Hospital of LUHS Kaunas Clinics for limited partial fasciectomy in 2017 – 2019. Diagnosis of DC was based on physical examination. Extension deficit was measured by goniometry, staging of DC was done according to Tubiana classification. Patients with multiple digit contractures were counted as a single case, taking the finger with the most expressed contracture as a reference. Furthermore, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was performed. Follow-up examinations were carried out after 6 and 12 months postoperatively. Data was analyzed using IBM SPSS Statistics 23.0. The repeated measures ANOVA with post hoc tests was used to compare means of normally distributed data according to Kolmogorov-Smirnov and Shapiro-Wilk tests. For verification of hypothesis significance level of p<0.05 was chosen. Resu [...].

Introduction Reckless use of fireworks, self-made bombs or careless behavior with military grade explosives can lead to debilitating hand and wrist structural injuries and burns. Aim To review and analyze common patterns, demographic data and results of blast hand and wrist trauma. Methods A retrospective study was conducted on patients treated in all Lithuanian hospitals and separately in Kaunas clinics. Demographic data was investigated in both all Lithuanian hospitals and Kaunas clinics but the more in-depth analysis on injured hand structures (bones, joints, tendons, arteries, nerves, skin) and treatment (wound dressing, primary sutures, fasciocutaneus wound covering, cross finger flaps) was performed only on patients treated in Kaunas clinics. Data from all Lithuanian hospitals were provided by the Lithuanian Institute of Hygiene [1]. Kaunas clinics data about the extent of injuries was obtained from physical and virtual patient medical histories provided by the department of statistics and archive of Kaunas clinics. Analysis was performed using SPSS 22.0 software package. Normality of data was checked by the Shapiro-Wilk and Kolmogorov-Smirnov test. Quantitative data were expressed as mean and interval (min-max values). Results From 1st January 2014 to 31st December 2019 a total of 387 patients suffered blast hand injuries in all Lithuania and Kaunas clinics combined. The most common cause of blast trauma was firework explosion in hand (78.81% of all blast related injuries). Throughout the years 143 of these patients were hospitalized in all Lithuanian hospitals, most of them in 2018 (n=50). 20.28% (n=29) of all hospitalized patients were children (<18 years). It was calculated that in whole country 26.61% (n=103) of all blast trauma patients were injured in the New Year period (from 31st December to 2nd of January). 53 blast hand trauma patients were treated in in the Kaunas clinics department of Plastic and reconstructive surgery. [...].

Background and objectives: Dupuytren’s contracture is a chronic fibroproliferative hand disorder with a varying pattern of genetic predisposition across different regions and populations. Traumatic events have been found to have influence on the development of this illness and are likely to trigger different clinical forms of this disease. The aim of this study was to evaluate the phenomenon of development of Dupuytren’s contracture (DC) following an acute injury to the hand, and to observe the incidence and clinical diversity of such cases in daily clinical practice. Materials and Methods: We collected data of patients presenting with primary Dupuytren’s contracture in the Lithuanian population and evaluated the occurrence and clinical manifestation of this specific type of DC, arising following acute hand trauma. The diagnosis of DC was based on clinical signs and physical examination. Digit contractures were measured by goniometry, and the staging was done according to Tubiana classification. Injury-induced (injury-related) cases were identified using the “Criteria for recognition of Dupuytren’s contracture after acute injury” (established by Elliot and Ragoowansi). Results: 29 (22%) of a total of 132 cases were injury-induced DCs. Twenty-six of 29 patients in this group presented with stage I–II contractures. Duration of symptoms was 6 (SD 2.2) and 3.8 (SD 2.2) years in the injury-related and injury-unrelated DC groups, respectively. Mean age on the onset of symptoms in the injury-induced and non-injuryinduced groups was 52 (SD 10.7) and 56 (SD 10.9), respectively. Patients from both groups expressed strong predisposition towards development of DC. Conclusions: Around one-fifth of patients seeking treatment for primary Dupuytren’s contracture seemed to suffer from injury-induced Dupuytren’s contracture. [...].